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PATIENT CARE PROCESS

Patient Care Process for Nausea and Vomiting

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Collect

  • Patient characteristics (e.g., age, sex, pregnancy status, triggers)

  • Patient medical history (personal and family), history of NV

  • Social history (e.g., tobacco/ethanol/cannabis use) and dietary habits

  • Current medications including: prescription, non-rescription, herbal products, dietary supplements

  • Objective data (e.g., QTc prolongation, BP/pulse, complete metabolic panel, CBC, liver function, weight, skin turgor, urine output)

Assess

  • Duration, frequency, severity of nausea and vomiting

  • Ability/willingness to pay for treatment options

  • Emotional status (e.g., presence of anxiety, depression)

  • Assess ability of the patient to use oral, rectal, injectable, or transdermal medications

  • Success of previous antiemetic regimens

  • For CINV: Assess emetic risk of chemotherapy (see Table 35-2)

  • For PONV: Assess risk factors for developing PONV (see Table 35-5)

Plan*

  • Drug therapy regimen including specific antiemetic(s), dose, route, frequency, and duration (see Tables 35-3, 35-6)

  • Monitoring parameters including efficacy (e.g., reduction in symptoms, resolution of laboratory test abnormalities, resumption of normal oral intake) and safety (e.g., QTc prolongation, drug-drug interactions); frequency and timing of follow-up

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, invasive procedures, drug-specific information, medication administration technique)

  • Self-monitoring for resolution of symptoms, when to seek emergency medical attention

  • Referrals to other providers when appropriate (e.g., gastroenterologist, dietitian, OBGYN, oncologist, anesthesiologist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up, adherence assessment

Follow-up: Monitor and Evaluate

  • Resolution of nausea and vomiting symptoms

  • Evaluate need for rescue antiemetics

  • Presence of adverse effects

  • Patient adherence to treatment plan

*Collaborate with patient, caregivers, and other health professionals

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 27. Nausea and Vomiting.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Nausea and/or vomiting is often a part of the symptom complex for a variety of gastrointestinal (GI), cardiovascular, infectious, neurologic, metabolic, or psychogenic processes.

  • Image not available. Nausea or vomiting is caused by a variety of medications or other noxious agents.

  • Image not available. The overall goal of treatment should be to prevent or eliminate nausea and vomiting regardless of etiology.

  • Image not available. Treatment options for nausea and vomiting include drug and non-drug modalities such as relaxation, biofeedback, and self-hypnosis.

  • Image not available. The primary goal with chemotherapy-induced nausea and vomiting (CINV) is to prevent nausea and/or vomiting and the emetic risk of the chemotherapeutic regimen is a major factor to consider when selecting a prophylactic regimen.

  • Image not available. Patients at high risk of vomiting should receive prophylactic antiemetics for postoperative nausea and vomiting (PONV).

  • Image not available. Patients undergoing radiation therapy (RT) to the upper abdomen or receiving total or hemibody irradiation should receive prophylactic antiemetics for radiation-induced nausea and vomiting (RINV).

  • Image not available. Beneficial therapy for patients with balance disorders can most reliably be found among the antihistaminic–anticholinergic agents.

Nausea and vomiting are common complaints from individuals of all ages. Management can be simple or detailed ...

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